PrEP Recommendations for High-Risk Cisgender Females

Introduction to PrEP

• The American College of Physicians recommends daily emtricitabine/tenofovir disoproxil fumarate (TDF/FTC) for cisgender women at risk of HIV through vaginal exposure, with a high level of evidence (AIa) 1, 2, 6

Rationale for Daily TDF/FTC

• Daily dosing of TDF/FTC is essential for adequate tissue protection in women due to lower vaginal tissue drug concentrations and faster clearance 3, 4
• The Centers for Disease Control and Prevention (CDC) recommends a minimum 7-day lead-in period to achieve adequate tissue levels for vaginal exposures 6, 7

Patient-Specific Risk Assessment

• The CDC recommends PrEP for populations with HIV incidence above 2% per year, including those with high STI exposure risk, such as individuals with multiple episodes of gonorrhea in 6 months 3, 4, 10

Pre-Initiation Requirements

• The World Health Organization (WHO) recommends obtaining combined HIV antibody and antigen testing, serum creatinine with calculated creatinine clearance, hepatitis B surface antigen, hepatitis C antibody, pregnancy test, and comprehensive STI screening before prescribing TDF/FTC 1, 2, 7, 10

Monitoring Schedule

• The CDC recommends quarterly follow-up, including HIV testing every 2-3 months, pregnancy testing, STI screening every 3-6 months, and creatinine clearance at 3 months, then every 6 months 1, 2, 10

Critical Counseling Points

• The American College of Obstetricians and Gynecologists (ACOG) emphasizes that PrEP does not prevent other STIs, and condoms remain essential for STI prevention 3, 4, 6
• The WHO states that TDF/FTC has a favorable safety profile, with only 2% discontinuing due to adverse effects, and common side effects are typically self-limited 8

Pregnancy Considerations

• The CDC recommends TDF/FTC as the preferred regimen for individuals of childbearing potential, as it is safe during pregnancy and breastfeeding, with no adverse effects documented in infants exposed during pregnancy 7, 10